Expert Perspective – Evaluating Patient Falls in a Hospital Setting

Sitzer 2016 states that hospital fall rates range from 1.3 to 8.9 falls per 1000 patient days and average 3.16 falls per 1000 days. Patient falls with injury are costly to our healthcare systems. They are considered a hospital acquired condition (HAC) or a “never event” by the Joint Commission and the Centers for Medicare and Medicaid Services. In 2008, the Centers for Medicare and Medicaid Services (or CMS) stopped reimbursement to hospitals for eight HACs that included patient falls.

Patient falls are a growing problem. Healthcare facilities are actively trying to address this through fall prevention programs and policies that address both the identification of high risk for injury patients; as well as instituting practices that help prevent falls. For litigators, learning how these programs and best practices are helping to reduce patient falls, as well as widely accepted risk factors for patient falls, will give a better understanding of how to address hospital fall cases from either the plaintiff or defense perspective.

It should always be assumed that every patient in a healthcare facility is at risk for falls. Patient falls are considered a “nurse sensitive” indicator. Because prevention of falls depends on the quantity and quality of nursing care. Upon admission, all patients should be assessed for their specific risk for falls. For years, we have assumed that patients 85 or older (the “frail” elderly) were at high risk. These days, many healthcare facilities are using the younger age of 70 as a baseline.

In addition to age, other factors should be considered when assessing for injury risk. Factors like osteoporosis, metasatases to the bone from cancer and other conditions affecting the strength of the bone should also be considered. Other risk for injury factors that should be considered in the assessment of patients are coagulation factors. For example, is the patient on anticoagulants, or do they have a bleeding disorder? Major surgery would also be another risk for injury factor, as the surgical wound could dehise in a fall.

Obviously, cognitively impaired patients are also at high risk for falls with injury. Impaired mobility of any kind and of course medications put patients at risk for falls and for possible resulting injuries. Lastly, any person who has a history of falling would obviously be at high risk for falls with injuries.

Medications can also play a huge role in patient falls. A Minnesota Adverse Health Events public report revealed that over half of all patients with a serious type of fall were taking one or more types of medications that were known to increase falls risk within 24 hours of their fall. Because the elderly metabolize and excrete medications more slowly, they are often affected more adversely when taking multiple medications. Thus they are an even greater risk for falls under these conditions.

Poor communication can also be a risk factor. Good signage that identifies bathrooms, doors, and rooms is important, since they allow patients to easily navigate their surroundings. Communication with patients and their families is also a key factor, as is good communication between healthcare staff. Poor communication in reports and hand offs can contribute to the probability of a patient fall. Every healthcare worker who comes into contact with a patient that has been identified as a high risk for injury should have visual and verbal cues that assist them in recognizing those patients and taking the needed precautions. This could be in the form of colored socks, signage, arm bracelets, and more.

Since all patients should be assumed to be at risk for falls it is important that they are assessed and monitored regularly. Because as patient’s conditions can change, so can their risk for injury from falls. Regular and intentional safety rounding on patients is essential to any fall prevention program. Volunteer or paid sitters for patients who are at very high risk for falls with injury should be considered as a choice if no other continual monitoring is available.

In summary, patient falls are preventable with the right policies and processes in place that assure patient safety. Healthcare facilities should recognize that all patients are at risk for falls and need to be on a fall prevention program. Further, assessments should include their risk for injury by assessing certain high risk factors and taking appropriate action to protect the patient.